Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association
Open accessAbstract
AIMS: Deep infiltrative endometriosis (DIE) may cause pelvic pain and thus negatively affect the function of different structures. We hypothesised that women with DIE may have dysfunctions of the pelvic floor muscles (PFMs) and lower limb muscles (LLMs). METHODS: This cross-sectional study included 160 women (80 with DIE under hormonal treatment and 80 women without DIE), who were assessed to determine the presence of pelvic symptoms (dysmenorrhea, chronic pelvic pain [CPP], deep/penetration dyspareunia, dysuria, dyschezia and vulvodynia), PFM function (PERFECT scheme, presence of hypertonia and trigger points, and muscle contraction and relaxation), abdominal muscle pain (Carnett's test) and muscle shortening in LLM (Thomas, Pace and Ober tests). RESULTS: Women with DIE presented more CPP (30% vs 5%; P < .001), dysuria (12.5% vs 3.75%; P = .043) and dyschezia (47.5% vs 2.5%; P < .001) than the control group. Moreover, they had higher PFM hypertonia (28.75% vs 13.75%; P = .02), weaker PFM contraction (36.35% vs 2.5%; P < .001), and incomplete PFM relaxation (45% vs 13.75%; P < .001). Women with DIE had a higher rate of positive results in the Carnett's test (21.25% vs 2.5%; P < .001) than the control group. Moreover, they had a higher frequency of shortening of the anterior thigh (30% vs 10% in both LLM; P < .001), piriformis (16.25% vs 6.25%; P < .001) and iliotibial band muscles (bilateral; P < .001). Multivariate analysis revealed that the presence of pain increased the risk of PFM hypertonia (OR = 3.73 [1.26-11.07]; P = .018) and caused difficulty in PFM relaxation (OR = 2.98 [1.01-9.37]; P = .049). CONCLUSION: Women with DIE exhibited a greater number of pelvic symptoms and greater PFM/LLM dysfunction than those in the control group. Pain was associated with PFM hypertonia and difficulty in PFM relaxation.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Women with deep infiltrating endometriosis may have dysfunctions of the pelvic floor muscles and lower limb muscles, and pain is associated with pelvic floor muscle hypertonia and difficulty in pelvic floor muscle relaxation.
“Studies indicate that women with DIE may have dysfunctions of the pelvic floor muscles (PFMs) and lower limb muscles (LLMs). Pain was associated with PFM hypertonia and difficulty in PFM relaxation [41].”
From Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature) (2021) · cites this paper as [41]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
HUSKISSON, E. C. (1974) · The Lancet · doi:10.1016/s0140-6736(74)90884-8 · Cited by 4,533 · see citing works
Pathogenesis and pathophysiology of endometriosis
Burney, R. O., & Giudice, L. C. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2012.06.029 · Cited by 1,590 · see citing works
Bulun, S. E., Yilmaz, B. D., Sison, C., Miyazaki, K., Bernardi, L., Liu, S., Kohlmeier, A., Yin, P., Milad, M., & Wei, J. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00242 · Cited by 844 · see citing works
Pelvic Floor Muscle Assessment: The PERFECT Scheme
Laycock, J., & Jerwood, D. (2001) · Physiotherapy · doi:10.1016/s0031-9406(05)61108-x · Cited by 626 · see citing works
Arruda, M. S. (2003) · Human Reproduction · doi:10.1093/humrep/deg136 · Cited by 373 · see citing works
Recognition and management of nonrelaxing pelvic floor dysfunction
Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2011.09.004 · Cited by 220 · see citing works
Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain
Stratton, P., Khachikyan, I., Sinaii, N., Ortiz, R., & Shah, J. P. (2015) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000000663 · Cited by 203 · see citing works
Update on endometriosis pathogenesis
Czyzyk, A., Podfigurna, A., Szeliga, A., & Męczekalski, B. (2017) · Minerva Obstetrics and Gynecology · doi:10.23736/s0026-4784.17.04048-5 · Cited by 114 · see citing works
Talasz, H., Kremser, C., Köfler, M., Kalchschmid, E., Lechleitner, M., & Rudisch, A. (2010) · International Urogynecology Journal · doi:10.1007/s00192-010-1240-z · Cited by 112 · see citing works
Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic.
Tu, F. F., As‐Sanie, S., & Steege, J. F. (2006) · PubMed · Cited by 98 · see citing works
Pathophysiology of Pelvic Floor Hypertonic Disorders
Butrick, C. W. (2009) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2009.08.006 · Cited by 98 · see citing works
Musculoskeletal Causes of Chronic Pelvic Pain
Gyang, A. N., Hartman, M., & Lamvu, G. (2013) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e318283ffea · Cited by 96 · see citing works
Reliability of the Thomas test for assessing range of motion about the hip
Peeler, J. D., & Anderson, J. E. (2007) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2006.09.023 · Cited by 95 · see citing works
Lahaie, M.-A., Amsel, R., Khalifé, S., Boyer, S. C., Faaborg-Andersen, M., & Binik, Y. M. (2014) · Archives of Sexual Behavior · doi:10.1007/s10508-014-0430-z · Cited by 83 · see citing works
Quality of Life in Women with Deep Endometriosis: A Cross-Sectional Study
Yela, D. A., Quagliato, I. D. P., & Benetti-Pinto, C. L. (2020) · Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics · doi:10.1055/s-0040-1708091 · Cited by 54 · see citing works
Self-citationDiagnostic Usefulness of Carnett's Test in Psychogenic Abdominal Pain
Takada, T., Ikusaka, M., Ohira, Y., Noda, K., & Tsukamoto, T. (2011) · Internal Medicine · doi:10.2169/internalmedicine.50.4179 · Cited by 53 · see citing works
Halpin, R. J., & Ganju, A. (2009) · Neurosurgery · doi:10.1227/01.neu.0000335788.45495.0c · Cited by 51 · see citing works
Assessment of pelvic floor muscles in women with deep endometriosis
dos Bispo, A. P. S., Plöger, C., Loureiro, A. F., Sato, H., Kolpeman, A., Girão, M. J. B. C., & Schor, E. (2016) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-016-4025-x · Cited by 45 · see citing works
Stenson, A. L. (2017) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2017.05.008 · Cited by 40 · see citing works
Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain
Sedighimehr, N., Manshadi, F. D., Shokouhi, N., & Baghban, A. A. (2017) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2017.05.001 · Cited by 36 · see citing works
Musculoskeletal Considerations in Female Patients with Chronic Pelvic Pain
Carrillo, J. F., Witzeman, K. A., Alappattu, M. J., & Lamvu, G. (2018) · Seminars in Reproductive Medicine · doi:10.1055/s-0038-1676085 · Cited by 33 · see citing works
Kannan, P., Winser, S. J., Goonetilleke, R. S., & Cheing, G. L. Y. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1468934 · Cited by 21 · see citing works
Cameron, B., Sabourin, J., Sanaee, M., Koenig, N. A., Lee, T., & Geoffrion, R. (2018) · Neurourology and Urodynamics · doi:10.1002/nau.23896 · Cited by 20 · see citing works
Macedo, C. D. S. G., de Souza, P. R., Alves, P. M., & Cardoso, J. R. (2009) · Fisioterapia e Pesquisa · doi:10.1590/s1809-29502009000300008 · Cited by 13 · see citing works
Incidence des troubles posturaux chez les patients souffrant d’algies pelvipérinéales chroniques
Iacazio, S., Foisy, A., Tessier, A., Riant, T., Ploteau, S., Perrouin‐Verbe, M., Rigaud, J., & Levesque, A. (2018) · The French Journal of Urology · doi:10.1016/j.purol.2018.05.002 · Cited by 5 · see citing works
Flagged first, then by citations
1 of the 26 references couldn’t be matched to a known paper.
Research works printed but not linked: 6
- Mehedintu C, Plotogea MN, Lonescu S, Antonovici M. Endrometriosis still a challenge. J Med Life. 2014;7:349-357.
- Czyzyk A, Podfigurna A, Szeliga A, Meczekalski B. Update on endo- metriosis pathogenesis. Minerva Ginecol. 2017;69:447-461.
- Stenson AL. Vulvodynia: diagnosis and management. Obstet Gynecol Clin North Am. 2017;44:493-508.
- Dezan VH, Sarra FTA, Rodacki ALF. Postural alterations, muscle disbalances and lumbar pain for olimpic athletes. R. Bras Ci e Mov. 2004;12:35-38.
- Macedo CSG, Souza PR, Alves PM, Cardoso JR. Study of valid- ity and intra and inter-observer reliability of modified-modified Schöber test in subjects with low-back pain. Fisioter Pesqui. 2009;16:233-238.
- Lacazio S, Foisy A, Tessier A, et al. Incidence of postural dis- orders in patients with chronic pelvic-perineal pain. Prog Urol. 2018;28:548-556.
Cited by
Sorted by citations
Smolarz, B., Szyłło, K., & Romanowicz, H. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms221910554 · Cited by 560 · see citing works
AAGL 2021 Endometriosis Classification: An Anatomy-based Surgical Complexity Score
Abrão, M. S., Andres, M. P., Miller, C. E., Gingold, J. A., Rius, M., Neto, J. S., & Carmona, F. (2021) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2021.09.709 · Cited by 132 · see citing works
McNamara, H. C., Frawley, H., Donoghue, J. F., Readman, E., Healey, M., Ellett, L., Reddington, C., Hicks, L. J., Harlow, K., Rogers, P. A. W., et al. (2021) · Frontiers in Reproductive Health · doi:10.3389/frph.2021.729642 · Cited by 100 · see citing works
Endometriosis and Adenomyosis: From Pathogenesis to Follow-Up
Martire, F. G., Costantini, E., d’Abate, C., Schettini, G., Sorrenti, G., Centini, G., Zupi, E., & Lazzeri, L. (2025) · Current Issues in Molecular Biology · doi:10.3390/cimb47050298 · Cited by 42 · see citing works
Mick, I., Freger, S. M., van Keizerswaard, J., Gholiof, M., & Leonardi, M. (2024) · Therapeutic Advances in Reproductive Health · doi:10.1177/26334941241277759 · Cited by 39 · see citing works
Kadah, S., Soh, S., Morin, M., Schneider, M. E., Heron, E. L., & Frawley, H. (2023) · The Journal of Sexual Medicine · doi:10.1093/jsxmed/qdac002 · Cited by 25 · see citing works
Del Forno, S., Raspollini, A., Doglioli, M., Andreotti, A., Spagnolo, E., Lenzi, J., Borghese, G., Raimondo, D., Arena, A., Rodriguez, E., et al. (2024) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-024-07643-7 · Cited by 19 · see citing works
Kadah, S., Soh, S., Morin, M., Schneider, M. E., Ang, W.-E. C., McPhate, L., & Frawley, H. (2023) · The Journal of Sexual Medicine · doi:10.1093/jsxmed/qdad089 · Cited by 14 · see citing works
da Silva, J. P., de Almeida, B. M., Ferreira, R. S., Lima, C. R. O. D. P., Barbosa, L. M. A., & Ferreira, C. W. S. (2023) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-023-07037-1 · Cited by 13 · see citing works
A Multimodal Approach to Symptomatic Endometriosis: A Proposed Algorithm for Clinical Management
Cetera, G. E., Merli, C. E. M., & Vercellini, P. (2025) · Reproductive Sciences · doi:10.1007/s43032-024-01763-w · Cited by 10 · see citing works
Holistic approaches to living well with endometriosis
Desai, J., Strong, S., & Ball, E. (2024) · F1000Research · doi:10.12688/f1000research.142586.2 · Cited by 9 · see citing works
Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome
da Cunha, R. M., Veloso, M. O., Coutinho, S. S., Braga, L. D. D. M., de Barros, A. S., Magalhães, G. M., Lima, P. O. D. P., do Nascimento, S. L., & Bezerra, L. R. P. S. (2024) · Revista Brasileira Ginecologia e Obstetrícia · doi:10.61622/rbgo/2024rbgo40 · Cited by 7 · see citing works
Winder, B., Lindegren, K., & Blackmon, A. (2023) · Journal of Dance Medicine & Science · doi:10.1177/1089313x231176629 · Cited by 5 · see citing works
Manu, A., Poenaru, E., Duică, F., Stoleru, S., Bauşic, A. I. G., Coroleuca, B.-C., Coroleucă, C. A., Iacob, C. M., & Brătilă, E. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14207256 · Cited by 4 · see citing works
Orlandi, S., Bocus, P., Geccherle, A., Ruffo, G., & Ceccaroni, M. (2024) · International Journal of Colorectal Disease · doi:10.1007/s00384-024-04757-x · Cited by 4 · see citing works
Consensus on Symptom Selection for Endometriosis Questionnaires: A Modified e‐Delphi Study
Zhu, T., Marschall, H., Hansen, K. E., Horne, A. W., Saraswat, L., Zondervan, K. T., Missmer, S. A., Hummelshøj, L., Bokor, A., Østrup, C. S., et al. (2025) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.18066 · Cited by 4 · see citing works
Manzi, V., Vannuccini, S., Nacci, F., Mauro, I., Gallone, A., Giani, M., Guiducci, S., & Petraglia, F. (2025) · Journal of Endometriosis and Uterine Disorders · doi:10.1016/j.jeud.2025.100135 · Cited by 3 · see citing works
Zelovich, T. E., Erenberg, M., Klaitman, V., & Yanover, C. (2025) · npj Women s Health · doi:10.1038/s44294-025-00073-z · Cited by 2 · see citing works
Piriformis muscle pain syndrome: the myths and reality
Ахмеджанова, Л. Т., Isaikin, A. I., Васильевна, В. Н., Busol, V. N., Bashkatova, M. M., Efimova, E. T., & Upatova, A. G. (2024) · Meditsinskiy sovet = Medical Council · doi:10.21518/ms2024-294 · Cited by 2 · see citing works
Gabrielsen, R., Bø, K., Engh, M. E., & Tennfjord, M. K. (2025) · International Urogynecology Journal · doi:10.1007/s00192-025-06190-2 · Cited by 1 · see citing works
Karp, B. I., Tandon, H. K., Sinaii, N., Aredo, J. V., Phan, V. T., Salmeri, N., Shah, J. P., Merideth, M. A., & Stratton, P. (2026) · EClinicalMedicine · doi:10.1016/j.eclinm.2025.103740 · Cited by 1 · see citing works
Şener, S., & Özkan, T. D. (2026) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.1177/10538127261434999 · Cited by 1 · see citing works
Vázquez-Camacho, A., & Reyes, G. R. (2023) · Revista Mexicana de Cirugía Endoscópica · doi:10.35366/114304
Arnal-Gómez, A., Arranz-Martín, B., Monzani, L., Martínez-Alexandre, C., Hortelano-Molina, A., & Fuentes-Aparicio, L. (2025) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2025.10.057
Multimodale Schmerztherapie bei Endometriose: Was bedeutet das? Wer profitiert von was?
Erlenwein, J., & Mechsner, S. (2026) · Die Gynäkologie · doi:10.1007/s00129-026-05519-2
Kapurubandara, S., Tan, V., Bimani, N., Nesbitt-Hawes, E., Deans, R., Sansom-Daly, U., & Abbott, J. (2026) · Journal of minimally invasive gynecology · doi:10.1016/j.jmig.2026.07.034
Pelvic health physiotherapy and its role in the treatment of endometriosis. A pilot study
Hosni, M. M., Jones, V., & Disu, S. (2026) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.1177/22840265261476529
Мурзин, М. О., Frank, M. A., Обоскалова, Т. А., Zamyatin, A., & Протопопова, В. Л. (2026) · Ural Medical Journal · doi:10.52420/umj.25.4.121
Šumak, R., & Serdinšek, T. (2026) · International Urogynecology Journal · doi:10.1007/s00192-026-06957-1
- Authors
- Fraga, M. V., Oliveira Brito, L. G., Yela, D. A., Mira, T. A., & Benetti‐Pinto, C. L.
- Affiliations
- Universidade Estadual de Campinas (UNICAMP) (BR)
- Department of Obstetrics and Gynecology School of Medical Sciences University of Campinas Campinas Brazil
- Corresponding author
- Benetti‐Pinto, Cristina Laguna
- ORCID
- Venue
- International Journal of Clinical Practice
- Publisher
- Wiley
- Published
- 2021-05-24
- Volume
- 75
- Issue
- 8
- Pages
- e14350-e14350
- ISSN
- 1368-5031 (ISSN-L)
- 1742-1241
- OpenAlex
- W3161454021
- Cited by
- 29
- References
- 26
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 6 · 2023: 5 · 2021: 3
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- International Journal of Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (001)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- deep infiltrating endometriosis, pelvic floor muscle dysfunction, chronic pelvic pain, pelvic floor relaxation, piriformis muscle, iliotibial band, dyschezia, dysuria, dyspareunia, hormone therapy, pelvic pain, women's health, pelvic floor physiotherapy, trigger points
- MeSH terms
- Cross-Sectional Studies, Endometriosis, Female, Humans, Muscle Contraction, Pelvic Floor, Vulvodynia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
